Print form and scan-email
to: info at HBCE.com, or
fax to: 941-484-1410
CONFERENCE REGISTRATION FORM
21st Annual National
Health Benefits Conference & Expo (HBCE)
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January 31 - February 1, 2012
Sheraton Sand Key Resort, Clearwater Beach, FL
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REGISTRATION FEES - SAVE YOUR SPACE - BEST CONFERENCE VALUE FOR 2012
Private Employer Gov't./Educ./Non-Profit Commercial ( * footnote)
by 01/27 >01/27 by 01/27 >01/27 by 01/27 >01/27
1st Person $345 $395 $295 $325 $395* $445*
Second 325 375 275 295 375 425
Third 295 345 250 275 345 395
Fourth FREE ------- > FREE ---- > FREE ---- >
Optional Post Conference
Workshop(w/ lunch)** 75 85 60 70 85* 95*
* Commercial: Consultant or supplier of health services or other products / services to employers.
** Workshops: (A) Workers' Comp (B) The New Health Age: Future of Health Care (C) Financial Education for Wellness & ROI
No penalty if cancel by 1/14/12; $50 after that date. Substitutions allowed by calling HBCE (941-484-1430) ahead of time.
Name & Title:______________________________________________________________________________
Name & Title (2nd):__________________________________________________________________________
Company/Employer:_________________________________________________________________________
Street:____________________________________________________________________________________
City:________________________________________State:__________Zip:____________________________
Phone:_____________________________________________Fax:___________________________________
E-mail(s):_________________________________________________________________________________
Please make CHECKS payable to:
Health Benefits Conference & Expo
Send to:
500 The Esplanade, Suite 205
Venice, FL 34285-1533
Phone: 941-484-1430
Fax: 941- 484-1410 (many complete
this form and FAX with payment
by credit card or send check later)
E-mail: info (at) HBCE.com - another option is to
scan this as an attachment and email to HBCE.
_____ Please invoice/bill my employer.
Or pay by CREDIT CARD & mail or FAX to: 941- 484-1410
Credit Card (circle or check) MC___ VISA___ AMEX___
Card No.__________________________________
CVV #: 3 #s on back, except AMEX (4 #s on front)_______
Exp. Date______________Total $______________
Signature _________________________________
Name on Card______________________________
TIN / EIN: 20-1571141
TAX DEDUCTIBILITY: Expenses of training, including registration, lodging & meals, incurred to maintain
or improve skills in your profession, may be tax deductible. Consult your tax advisor.
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